To assess the influence of treatment in institutional and community care settings on the sexual networks and HIV risk behaviors of individuals diagnosed with severe mental illness (SMI), Wright and Gayman (2005) interviewed 401 clients in two state psychiatric hospitals and three community mental health centers. Wright and Gayman found that "community clients are more likely than hospital patients to be currently sexually active and to engage in high-risk sexual behavior whereas hospitalized patients tend to have more transient sexual relationships with partners who also have a mental illness" (p. 341). Regardless of treatment setting, however, a majority of clients who were sexually active reported engaging "in some risky sexual behavior with one or more of their partners during the past 3 months" (p. 349).
Drawing on these findings, the investigators contend that
mental health treatment settings influence the HIV risk of people with [SMI] primarily by shaping the overall likelihood that clients are sexually active and the composition of their sexual networks. Specifically, ... state hospitals may be facilitating the spread of HIV among individuals with SMI ... [by] concentrat[ing] sexual risk behavior within smaller, and generally closed networks of persons with SMI. ... These findings ... underscore the need for more comprehensive HIV prevention efforts that target state hospital patients ... [and] hint that state-hospital focused HIV prevention programs could potentially have a much broader and longer-term structural impact on the course of the epidemic by limiting the frequency of HIV transmission and/or risk behavior within the population of clients and patients with SMI.
In contrast, clients in outpatient care are more likely to be more successful in maintaining longer-term sexual relationships and having relationships with individuals outside of the mental health care system. Community-care clients' success in maintaining longer-term sexual partnerships represents an important strength that could have implications for HIV prevention programming. ... [This finding suggests] that mental health professionals could help to stem the spread of HIV indirectly by helping their clients, regardless of the treatment setting, to develop long-term relationships to meet their sexual needs. More generally, this finding ... [suggests] that prevention programs emphasizing safer-sex negotiation and relationship skills, especially relationship skill-building interventions [1] ..., may be particularly effective in community care settings because clients' existing sexual partnerships will offer mental health clinicians critical opportunities to counsel clients about HIV and help them practice risk reduction skills. (pp. 349-350)
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Winter 2006 Newsletter / Volume 7, Issue 2
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